In part II of our opinion series on opiate addiction in the United States, we will be examining how pharmaceutical companies have played a major role in the current crisis.
$245,812,399. That is how much the American pharmaceutical industry spent on lobbying in the year 2016. According to the Center for Responsive Politics, since 1998 the pharmaceutical industry has lobbied Washington with more money than any other industry. They have also donated generously to political campaigns. Since 1990, pharmaceutical campaign contributions have increased tenfold.
It is fair to say the pharmaceutical industry currently wields an unprecedented amount of power in the United States. With average 30% net margins, the sector is currently the most profitable industry in the world. But while these companies are beholden to their shareholders to make money, they also have a moral obligation to the patients that purchase and ingest their products. When it comes to opioids, the behavior of some companies places profits over people.
While attitudes in the medical community and marketing efforts by drug companies had already been shifting towards broader use of opiates for a few years, the epicenter of the opiate explosion can be traced to 1996 when Purdue Pharma unveiled OxyContin, a sustained release version of oxycodone. Purdue heavily marketed the drug, charging a premium due to the supposed 12 hour duration of the pill. Sales rose from $48 million in 1996 to $1.1 billion in 2000 (a nearly 2,300% increase). Despite its high risk for abuse and addiction, OxyContin was successful from a business perspective, so Purdue downplayed the risk of addiction in its promotional materials and in information provided to physicians. The company even trained its sales representatives to state the risk of addiction was lower than 1%. This misrepresentation was so egregious that in 2007 three executives were convicted of criminal misbranding for claiming that OxyContin was less addictive than other pain medications. An LA Times investigation shows that the drug often does not last for the purported 12 hours and therefore actually makes its users more prone to addiction. The story claims the company had known about this issue for decades.
What makes this situation so tragic is that many in the pharmaceutical industry supply chain are aware of the damage they are doing yet continue to carry on as usual due to high profits. This includes the drug makers, wholesalers, pharmacies, and even doctors. The Charleston Gazette-Mail’s incredible exposé, which won the 2017 Pulitzer Prize for Investigative Reporting, shows the staggering number of pain pills flowing into West Virginia, a state that has been especially ravaged by the epidemic. Their investigation uncovered (after much opposition from wholesalers) that over 780 million pain pills were shipped into the state between 2007 and 2012. West Virginia has the highest rate of overdoses in the United States. A former Wayne County Delegate stated, “Distributors have fed their greed on human frailties, and to criminal effect.”
The Gazette-Mail’s piece also reported greed at the pharmacy level, citing an example of a pharmacy that received 600% more oxycodone pills than a competitor right down the street. Each link in the supply chain points at the others when it comes to responsibility of opioid distribution. In another investigative report, the LA Times discovered that Purdue Pharma shipped over 1 million pills that had been prescribed by a single corrupt doctor despite concerns of criminal activity raised by their own sales representatives and data showing the suspect orders. As a result, a tiny pharmacy became the top seller of OxyContin in California due to these prescriptions and the pills ended up in the hands of organized crime groups. When questioned on the issue, Purdue’s general counsel deflected responsibility by stating the wholesaler has “their own order monitoring programs.”
This behavior has had a very real and negative impact on real people. The industry’s behavior needs to change, but outside pressure to do so is increasing. Many in the medical community are already recognizing that opioids are not the best way to treat pain long term. In 2016, the surgeon general issued a call to action in a report titled Facing Addiction in America, and elected officials in California and New Hampshire are calling for investigations into drug companies that produce opiates.
We as patients can also control how we deal with our pain by choosing natural treatments instead of narcotics. Part III of this series will detail how naturopathic treatments can effectively treat pain without the dangers of opiates.